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Note:
The following transcript can be accessed at http://www.parliament.uk/
House of Lords Debate on the Queen's Speech:
Earl Baldwin's statement, 13-12-2000.
Earl Baldwin of Bewdley: 6.35 p.m. 13 Dec 2000
: Column 427...... I turn lastly to the vexed
matter of water fluoridation. In the 1999 White Paper, Saving Lives:
Our Healthier Nation, the Government announced that they were setting
in motion an
"up-to-date expert scientific review of fluoride and
health".
Possible legislation was foreshadowed. Partly because of the many
questions I had tabled on this topic, and the debate in my name
in December 1998, I found myself on the advisory board to the review
team at the NHS Centre for Reviews and Dissemination at York, in
close contact with the scientific process from the summer of 1999
to the publication of the final report on
6th October this year.
The expectation of the dental and medical authorities, and it is
fair to say of the Government also, was that the safety and effectiveness
of fluoridation would be confirmed. That expectation was disappointed.
In addressing the five principal questions that were asked, the
report is studded with phrases such as "limited quantity",
"moderate quality", "a small number of studies",
"needs further clarification", "surprising to find
that little high quality research has been undertaken", "insufficient
quality to allow confident statements", "not...enough
good quality evidence...to reach conclusions". Important gaps
in the evidence base were identified.
I pay tribute to the Government for having agreed to institute a
high-quality scientific review--the first and only systematic, that
is unbiased, assessment of the evidence in half a century of water
fluoridation. I pay tribute to them for now taking steps, through
the Medical Research Council, to put some much-needed research in
hand, not before time. I cannot, however, pay tribute to the dental
lobby in the aftermath of the York report.
I am aware that many of your Lordships have had briefings from the
British Dental Association, the British Fluoridation Society and/or
the National Association for Equity in Dental Health. I am aware,
as we all are, that briefings by professional bodies, including
professors of dentistry, carry weight with the public, are likely
to be believed and therefore bear a particular responsibility for
accuracy. These briefings and press releases are little short of
extraordinary.
I have collated four pages of statements culled from these documents,
with alongside them for comparison quotations from the text of the
report itself. I can give the flavour of them in two or three short
examples. I have placed copies in the Library for those who would
like to read more.
The British Dental Association says,
"The report confirms that there is clear
evidence that fluoridation reduces [decay]";
the report says,
"To have clear confidence in the ability
to answer [this] question...the quality of the evidence would
need to be higher".
Column 428
The British Dental Association says,
"There is no evidence that...fluoridation is linked
to cancer, bone disease or any other adverse effect"; and,
"The report confirms that fluoridation reduces dental health
inequalities";
the report says,
"The research evidence is of insufficient quality
to allow confident statements about other potential harms [than
dental fluorosis] or whether there is an impact on social inequalities".
The British Fluoridation Society says,
"If there were any adverse effects...it is inconceivable
that the York review would have missed them";
the York review says,
"Some possible adverse effects...may take years to develop
and so...the relationship may go undetected", and, "High
quality research [into adverse effects]...is needed".
One might have thought, if one did not know that fluoridation
had been an article of dental faith for fifty years, that this
was simply carelessness. Such a thought is dispelled when one
finds a wrong figure quoted for seriously mottled teeth, which
could only be cited by the author having read, and misinterpreted,
some of the very small print.
This is an important public health issue. It is not the Government
who are likely to be misled by such inaccurate statements--at
least I hope not--so much as local councils, the public and, dare
I say it, Members of Parliament, who have even been urged to put
down Questions on this false basis. It is essential to put the
record straight. Anyone in doubt about the facts should, as always,
go to primary sources. The York report is a long one, but the
summary and conclusions are only four pages each and are not hard
to understand. I would urge any noble Lord who is thinking of
tabling Questions not to rely on briefings, whether from dentists
or opponents, but to go to the report itself.
Because I am known to oppose the fluoridation of water, I have
taken the greatest care to keep in step with the leading scientists
at York and to write and say nothing in interpretation of their
report which goes beyond the evidence. I have the permission of
Professor Sheldon, the founding director of the NHS Centre for
Reviews and Dissemination at York, who chaired the advisory board
which oversaw the whole review process, to quote him as follows.
"It is particularly worrying...that statements which mislead
the public about the review's findings have been made in press
releases and briefings by the British Dental Association, the
National Alliance for Equity in Dental Health and the British
Fluoridation Society. I should like to correct some of these errors".
He continues:
"1. Whilst there is evidence that water fluoridation
is effective at reducing caries, the quality of the studies
was generally moderate and the size of the estimated benefit,
only of the order of 15%, is far from 'massive'.
"2. The review found water fluoridation to be significantly
associated with high levels of dental fluorosis, which was not
characterised as just a 'cosmetic issue'.
"3. The review did not show water fluoridation
to be safe. The quality of the research was too poor to establish
with confidence whether or not there are potentially important
adverse effects in addition to the high levels of fluorosis. The
report recommended that more research was needed.
"4. There was little evidence to show that water fluoridation
has reduced social inequalities in dental health".
I shall skip most of what follows and just give Professor Sheldon's
final point. He states:
"The review team was surprised that in spite of the
large number of studies carried out over several decades there
is a dearth of reliable evidence with which to inform policy.
Until high quality studies are undertaken...there will continue
to be legitimate scientific controversy over the likely effects
and costs of water fluoridation".
My only questions to the Minister, in the light of the state
of the evidence as set out by one of the two principal scientists
involved in the review and of these extraordinary briefing papers,
are whether the Government still think it appropriate, first,
to go on making financial contributions to the British Fluoridation
Society, and, secondly, to encourage certain health authorities,
as they have said that they would, to consider water fluoridation
schemes. The noble Lord would also do me a good turn if he could
secure for me a reply from his colleague the Secretary of State
to the personal letter I wrote to him on this matter on 5th August,
repeated on 7th October, and reminded again on 14th November.
With fluoridation, things tend to take a long time.
Lord Colwyn: 8.47 p.m. Column
459-460 (i.e. much later)
Perhaps I may touch briefly on fluoridation. I am well aware that
the noble Earl, Lord Baldwin, will have given an opposite view
to mine. The recent York Review has confirmed that fluoridation
is safe and effective in reducing levels of tooth decay and is
essential in the fight to reduce inequalities in dental health.
The Government have announced that they will be,
"encouraging health authorities with
particular dental health problems to consider fluoridating their
water as part of their overall health strategy".
In recent years more than 50 health authorities with particular
dental health problems have persistently attempted to implement
water fluoridation. They have conducted extensive publicity and
consultation exercises and have demonstrated substantial public
and local authority support. Despite that, each health authority
has had its request for fluoridation refused by its water supplier.
Can the Minister confirm the Government's White Paper commitment
to introduce a legal obligation on water companies to fluoridate
where there is strong local support for doing so and give the dental
profession an absolute assurance that this policy will be implemented? |
